Proper physiological conservation of an amputated member is essential if an attempt at reimplanting the member by micro-surgical techniques is to be successful.
At ambient temperature, the maximum waiting period is three hours.
If the member is cooled to a temperature in the range 2.degree. C. to 4.degree. C. at the moment of amputation, it may be conserved for as long as 36 hours.
It may still be conserved for as long as 22 hours after being exposed to ambient temperature prior to cooling for a period not exceeding two hours.
These periods apply to fragments of small size (fingers), they are considerably shortened (8 to 12 hours) once the volume is greater (limbs) or the fragment contains muscle, and also because it is more difficult to obtain uniform cooling. Excessive cooling below 0.degree. C. gives rise to frost lesions and makes failure inevitable.
The first and most important problem, since success or failure depends upon it, is thus the problem of conserving the member as quickly as possible by cooling it, and transporting the member to a reimplantation center under proper temperature conditions.
The method currently used is to insert the fragment in a sealed plastic bag which is put on ice. This has several drawbacks as has been shown by various "SOS Hands" services:
the cooling is uneven;
the fragment may be damaged by direct mechanical contact; and
some parts of the fragment may be frozen by direct contact with the ice or with icy water if the bag is not properly sealed, etc.
There is no way of knowing for sure during the operation whether one of these accidents has already occurred, and it is only after the operation has failed and it becomes apparent that is was useless or even damaging, that doubts arise. It is thus very much in the interest of the patient and of the surgeon to be sure prior to the operation that conservation has taken place under the best possible conditions.
Various scientific investigations have shown that for the best possible conservation:
the fragment must be inserted in a sealed bag;
the bag should be immersed in icy water rather than being put on ice in order to avoid partial freezing; and
depending on the school of thought, either the fragment should be left dry, or else it should be wrapped in a cloth which is impregnated with Ringer's liquid or with physiological serum, or it should be directly immersed in said liquids.
This is very difficult to do in practice with means that are improvised on the spot, and the risks of error by omission or by over-enthusiastic commission are great.
Preferred embodiments of the present invention provide the patients and the first aid practitioner with simple, safe and quick conservation means.